This is not always necessary but it helps reinforce your case. Get another person's opinion and document it. It is one thing for you to say the patient is not suicidal but it is tremendously helpful to have a family member tell you he is not, or that this situation is common, or that this happens whenever he gets upset. If you have made the clinical judgment that the patient is safe to go home and his wife also thinks it is okay, write that down. For example, "Spoke with his wife, who agreed with my plan; she said, 'I didn't think he needed to be hospitalized, but he did need to talk to someone.'"
It is important to note that you are making your own independent assessment, but you are using agreements from other persons to show support for your position.
Conversely, you need to explain clearly why your assessment differs from that of a family member. You do not have to agree with the family member, but you have to explain why you do not. If a wife says her husband needs hospitalization you must have a really good set of reasons for why he does not—so make a specific point of writing them down.
If family and friends are not available (document that you tried—that also shows effort and is above standard of care), get a second doctor, resident, nurse, or another clinician to concur so you can write the next very powerful sentence: "Discussed the situation with X, who also evaluated the patient, and X agreed with me."
Apart from giving you a valuable second opinion, this documenation also helps establish standard of care, loosely defined as how a respectable minority of clinicians in your situation would have proceeded. Two doctors are usually considered to be a respectable minority as far as I am concerned (and have testified as such).What did you do for the patient that made him safer for discharge?
"The plan is to let him decompress and regroup for an hour in the ED. We will give him lorazepam(Drug information on lorazepam) to help. I'll give him supportive therapy as well as try to teach him some better coping techniques for the future and have a nurse do the same to reinforce them."
Do not hide the fact that the patient disagreed with you, if he did. It shows that you heard him.
"I told him that I did not think hospitalization was the right course to take and I explained my reasons. While he was not happy with this—he wanted to be an inpatient—he at least understood my reasoning and was satisfied that I was actually trying to help him. Of course [note word choice], I called his [family member/friend] who agreed to come pick him up and stay with him continuously, not let him out of sight, and bring him back if things worsened. I explained how and when to give lorazepam, which helped in the ED."
If you are able and it is indicated, add: "I/therapist/nurse will follow up tomorrow to see how the patient did and if he took medication, etc." If you do write this in the report, make sure you actually do it!
Let me be clear. This report is not intended to convince you that the patient is not going to die. You have to already be convinced for yourself that despite his suicidality he will be alive tomorrow. Your clinical judgment comes first. Then, and only then, should you write a statement that supports and explains your decision.Write the report as if the patient died
Never change your report after the fact. The lawyers already have a copy before you get your subpoena.
But imagine you could change the report. What would you change? You will have wished you had written more about checking this, or the patient denying that. Well, write this all down now. Write what you will someday desperately wish you had written.
It is important to remember that if the patient does commit suicide you will be called to retrospectively address the risk factors, so address them explicitly now. "The main risk factors for suicide in this patient include a history of previous suicidality, a diagnosis of borderline personality disorder, and alcohol(Drug information on alcohol) abuse; however, he has not actually ever made an attempt, has been abstinent for 2 days (with low risk for withdrawal), is highly motivated to continue rehabilitation, and denies access to weapons (wife corroborates this)."